The Anxiety Epidemic

Our smartphones may be a major cause.

On June 11, a New York Times article, “An Anxious Nation,” chronicled how our society has seemingly become one where the diagnosis of anxiety now rivals that of depression. Poignantly the article suggests that, “Anxiety is starting to seem like a sociological condition, too: a shared cultural experience that feeds on alarmist CNN graphics and metastasizes through social media.” The article’s author, Alex Williams, provides some seriously worrisome statistics, including the fact that on college campuses anxiety disorders are now more common than depression, which has always been the leading mental health disorder among university students. Worse, the National Institute of Mental Health reports that 38 percent of teenage girls and 26 percent of teenage boys have an anxiety disorder.

Source: mediamodifier/pixabay

The recent phenomenon of the “fidget spinner”—a device originally developed to help children with anxiety, ADHD or autism—has seen explosive sales, particularly among children, adolescents, and young adults who appear to use it to alleviate anxious feelings.

One explanation for the spike in anxiety among teens and young adults may be found in the Times Sunday Review section that same day — “Texting With Boys.” Kaitlyn Greenidge discussed how we react with anxiety and apprehension while we watch someone with whom we are texting appear to be texting back as the “typing awareness indicator” bubbles parade in front of our face. It is truly mesmerizing for many and I have watched people stare at these dots for long periods of time and seen their moods vacillate from anticipation to sadness to anger. And it is entirely possible that the person is not texting at all but just left their cursor in the text box. Frustrating beyond belief.

So who gets more anxious as a result of technology usage? In a study published in 2014, Dr. Nancy Cheever and our lab conducted an experiment to see what would happen if we deprived college students the ability to access their smartphones and induced a state of boredom where they were not allowed to do anything. Sounds stressful, right? For some it was and for others, it was not. Over an hour-plus of boredom, we measured anxiety using a simple self-report scale (the state portion of the well respected State-Trait Anxiety Inventory) three times, after about 10 minutes, after about 30 minutes and again after about an hour. Turns out that when we looked at the daily smartphone use of our 163 subjects and split them into thirds, the bottom third, those who used their phone the least, showed no change in anxiety across the boring hour. The middle third did not show any increase in the first ten minutes but did increase their anxiety at the 30-minute testing and then stayed at a constant but moderate level of anxiety for the duration. The heaviest users, our top third, showed an increase in anxiety 10 minutes into the boring situation and continued to feel increasingly anxious throughout the hour-plus period far eclipsing the moderate users even after 30 minutes. What I didn't tell you is that half of the group had their phone taken away and replaced with a claim check and the other half had to turn their phone off and place it out of sight. It really didn’t matter: Turns out that out of sight is definitely not out of mind.

Cheever is now following up the study by examining the impact of a text message interruption on physiological signs of arousal and, perhaps, stress.

Source: Larry D. Rosen

You may have seen this experiment being performed on Anderson Cooper on an April 9, 2017 segment on 60 Minutes entitled "Brain Hacking." In a simulation of the study, Anderson was hooked up to a galvanic skin response (GSR) device, which monitors electrodermal activity (EDA) as well as a device monitoring his heart rate. EDA is that sweaty feeling that you feel when you are anxious or excited and your hands start to sweat a bit (happens to me during every episode of the television show 24). Anderson was instructed to read material on a screen and to leave his phone by his side. After a few minutes, Cheever told him that his phone was interfering with the electrical equipment and she needed to move it a few feet behind him. Shortly after, Cheever texted Anderson’s phone and we saw an immediate spike in his skin conductance. She did it four times and each time the GSR spiked. Finally, outside the protocol, she called his phone and got a huge reaction spike in GSR and he turned his head to try to see who was calling him. Earlier in the day when he was interviewing me, he admitted that he was not paying close attention to my answers because he had silenced his phone and put it on the floor at the foot of his chair and he was anxious about missing out on his texts and other messages. He was profoundly impressed by the strength of his anxiety reactions both in the experiment and during the interview.

Recent research has demonstrated the impact of even having a conversation with someone when a third person’s phone is placed nearby. In one study researchers placed either one of the two participants’ phones close by as they communicated or a phone that did not belong to either conversant. Following a 10-minute discussion between the two people, each person felt less close and less trusting of the other. In another study participants completed puzzles while the experimenter either called their phone (sitting on a table behind them) or did not call their phone. Those who endured a missed phone call showed increased anxiety as well as decreased performance on the puzzles compared to a group with no interruption. Another study indicated that even the “mere presence” of one’s phone led to decreased performance on all but the easiest tasks.

In our lab, we have tested models showing the impact of anxiety (as well as other variables such as executive functioning and boredom) in other domains. In a study of the impact of these variables on sleep problems among college students, we found that a particular form of anxiety that some call FOMO—“fear of missing out”—predicted more daily smartphone use, more preference for multitasking and more nighttime awakenings to check a phone which, in turn, predicted sleep problems. In another study, using a similar model to predict performance in an upper-division college general education course, FOMO directly predicted lower grades but also predicted more daily smartphone use, shorter attention span while studying and a lack of classroom digital “metacognition” (defined as knowing how to control your focus during lecture and not be distracted by technology) which, in turn, predicted poor grades.

Smartphones have been a major part of our world for a decade or so and it appears that they (and other devices, too) are having a deleterious effect on our mental and emotional functioning. People who use them a lot (and that is most of us) cannot seem to stay away from them and the research is pretty clear that one major cause is anxiety. Whether it is FOMO or some other technology-related anxiety is an open research question. Regardless, we know that some form of anxiety is driving us to check in constantly with our technology.

In the study mentioned earlier predicting course grades students installed an app on their computer called “Instant Quantified Self” which monitors smartphone use. The typical college junior/senior unlocked his/her phone 60 times a day for a total of 220 minutes. Try it yourself and see how often you check your phone. Also, pay attention to times when you “think” that your phone vibrated in your pocket or purse and find that either it didn’t or it wasn't even in that location. Normal neuronal activity, previously meriting a quick scratch to quell an itch, now is perceived as a phantom pocket vibration. That is a function of anxiety.

I get asked all the time by the media, by parents, by teachers and nearly every group I have spoken with in the past 10 years what I think long-term usage is going to do to our children. I think we are already seeing some of the ramifications. If anxiety disorders are increasing in teenagers, perhaps this is due to incessant smartphone use in general and use for communication purposes in specific. Our smartphone is a marvelous device that gives us more power than many computers and has everything we could want and need with us all day (and night) long. As companies vie for your attention you will be faced with new apps that allow you to do more and new websites that grab your attention. More of those bubbles will increase your anxiety. More social media platforms will demand your attention. The 60 Minutes segment on brain hacking tells you more about this and I encourage you to watch it as well as the auxiliary overtime material on 60 Minutes Overtime.

In the meantime, there are strategies you can use to moderate your smartphone usage and become a smarter, more focused and more productive user. You do not have to salivate like Pavlov’s dogs when your phone beeps or vibrates. You can avoid phantom vibrations. For clear strategies, take a look at the model that Adam Gazzaley and I present in our book, The Distracted Mind: Ancient Brains in a High-Tech World, in which we take a serious look at distraction from the dual perspectives of neuroscience and psychology. The final two chapters present strategies for saving your Humanware from those two perspectives.

Cheever, N.A., Rosen, L.D., Carrier, L.M., & Chavez, A. (2014). Out of sight is not out of mind: The impact of restricting wireless mobile device use on anxiety levels among low, moderate and high users. Computers in Human Behavior, 37, 290-297.

Adam Alter calls it the age of behavioral addiction. I often think of it as the information overload age. Kids AND adults are not only overstimulated by smartphones, but all technologies and marketing. The constant pings of work email and texts inject a steady stream of cortisol all day, every day, and don't help the matter. Social media for many is a cigarette, beer, and line of cocaine all in one. It's an addiction plain and simple.

Meditation and mindfulness have been key ingredients in helping curb my severe anxiety, which I had long before an internet dial-up connection entered my home in the mid to late 90s. Tech has for sure exacerbated the issue. We need, as a culture, to be aware of what's going on and aptly name it as Alter does.

This is fascinating research. After a concussion 2.5 years ago I had to restrict my screen time. Since then, I've used mindfulness and trained myself to wean off the FOMO and other internal triggers. I often keep my phone on Do Not Disturb And I minimize notifications to the absolute essentials. I've broken many of my destructive tech habits through implementing daily rituals and teach this to others.

That said there's a bigger issue here regarding cause and effect.

You write "People who use them a lot (and that is most of us) cannot seem to stay away from them and the research is pretty clear that one major cause is anxiety."

Yet in other places you suggest that anxiety is the effect of our reaching for the phone all the time.

I'm not a psychiatrist, but in my personal experience I've found that anxiety and depression are closely linked. What's the real cause for the spike in college age anxiety? Perhaps one reason is that more people are reporting those symptoms because they've been influenced by the push to "happiness" so they steer away from sharing their depression symptoms. Studies show that people often feel depressed from social media.

Just a lot of random thoughts to flesh out that there's a lot going on here. No question that we need a radical rethinking of how we interact with our technology.

Sorry for any confusion. Anxiety is one of the major causes of our seeming need to check in constantly and is the result of not being able to do so. Checking in then reduces the anxiety and the process builds again.

The cure is simple self-discipline. In addition, you can use certain habits and 'tricks' to make a better regiment. The devices should be useful tools at times, not addictions.

Whever possible (i.e. not on call at work or expecting some urgent contact, and here you must set strict guidelines with yourself over what "urgent" really means) keep phones far away most of the time, ideally in another room, with the sound off. Allow certain times to check them. Meanwhile go about your other activities without the interruption and distraction.

Also you must "train" others - associates, colleagues, friends, etc - of just how quickly you can be expected to respond to phone calls, texts, emails…if at all. If you spoil them by attempting to respond to every communication instantly, you set an extremely bad precedent for yourself, a standard you cannot maintain, and others will resent it if you are thenceforth the slightest bit slower in response.

The fact that studies show the increase of anxiety due to technology is not surprising. The main problem I see in this generation of teens and young adults is that these individuals rely too much on the instant gratification that technology produces, such as the “likes” they receive when posting a picture on one of their many apps or the response time to a text. Many people want to blame social media for the escalation of anxiety, along with other mental illnesses, when in actuality the lack of self discipline is the problem.